Thyroid problems can affect a woman at any age or stage in life – from the teens to retirement. Throughout this time, they are a source of much ill health and unhappiness. During the reproductive years and after the menopause, they can exacerbate other female health problems as well as create a host of debilitating symptoms that affect every system of the body:
• Thyroid problems can cause menstrual disturbances, such as heavy or absent periods, and worsen problems such as premenstrual syndrome (PMS).
• Thyroid problems are an underrecognized cause of fertility problems and miscarriage.
• During pregnancy, thyroid disorders are the most common hormonal problem.
• Even a mild shortage of thyroid hormone during pregnancy may affect the unborn child’s future IQ (intelligence quotient). Research shows that children, aged seven to nine, whose mothers had untreated hypothyroidism during pregnancy scored about seven points lower on IQ tests.
• According to US research, women with faulty thyroid function are more likely to give birth to babies with defects of the heart, brain or kidney, or have abnormalities such as a cleft lip or palate, or extra fingers.
• Babies whose mothers have an underactive thyroid have an increased risk of heart problems – even if their mothers are being treated for the condition. Yet, at the time of writing, the NHS still does not routinely test thyroid function in pregnancy.
• One in 10 young women have thyroid problems after giving birth, with symptoms such as depression, tiredness and a lack of zest that cast a shadow over the first months of parenthood. Such symptoms are often misdiagnosed as ‘the baby blues’, thus depriving women of treatment that would help.
• Later in life, thyroid disease becomes even more common. An estimated one in 10 women over 40 may have undiagnosed thyroid disease, which is particularly worrying as thyroid problems are associated with an increased risk of two very significant causes of female ill health in later life: heart disease and osteoporosis (brittle-bone disease).
• One in five women over 60 suffer thyroid problems. With the ‘baby-boomers’ reaching this age, thyroid disorders will become an increasingly major health challenge.
• Thyroid disease in older women is more likely to be ‘silent’, producing few or vague symptoms. But compared with, say, high blood pressure – another ‘silent’ disease with serious consequences – thyroid problems are far less likely to be suspected or tested for.
These facts and figures alone put thyroid disease on a par with conditions like diabetes, estimated to affect one to two in every 100 people, and breast cancer, which strikes one in eight women. However, thyroid problems attract only a fraction of the research funding given to these high-profile conditions, and have until only recently relatively poor media coverage. That this is now beginning to change was reflected by an editorial in the prestigious British medical journal The Lancet that declared ‘you’re only as healthy as your thyroid’.
Are Times Changing?
During the writing of the first edition of this book more than seven years ago, there was little awareness – even among journalists specializing in women’s health – of just how common thyroid problems are and of the misery they can cause. A small request for help placed in The Guardian newspaper resulted in a deluge of phone calls: 200 over two days.
Revisiting thyroid problems now, has anything changed? The good news is that there has been a shift in knowledge and attitudes. A great deal more is becoming understood in terms of how thyroid problems are caused and how they may best be treated. And certainly, many more people are now aware of thyroid disease than in 1995.
Part of this new awareness is thanks to a number of books drawing attention to the wide-ranging effects of thyroid problems and the misery they can cause. The advent of the Internet has also done much to fill the information gap. There are now several excellent websites where women with thyroid problems can get information and communicate with others who have the same condition. This is good news for the millions of women living with a faulty thyroid.
However, in other aspects, the changes have been pitifully few. Thyroid disease is still a ‘Cinderella’ disorder, despite being the cause of so much depression, tiredness, discomfort and feeling well below par. Even nowadays, women often soldier on for long periods before anyone takes their complaints seriously – hardly surprising given that the average medical student only has a lecture or two on thyroid problems, if they’re lucky. And although there are more post-training courses for interested doctors, endocrinology (the study of hormones) is still not a core subject in most basic medical courses.
Like their ‘sisters’ in 1995, many of the women interviewed for this new edition had struggled on for months, even years, with crippling symptoms before being diagnosed. Once diagnosed, they had to cope with unsympathetic doctors and endure treatments that were uncertain, took time to get right and sometimes didn’t work at all.
Just like seven years ago, many women also spoke of the dilemmas posed by treatment – how long it had taken for medications to start working, the uncertainty of their effects, the agony of deciding whether to opt for surgery or radioiodine therapy, or whether different forms of medication might be more effective. All related stories of how difficult it was to obtain relevant information and how alone they felt with this unpredictable disease.
Others told poignant stories of how the disease had affected their daily lives and relationships in the face of the pressures of holding down a job while battling overwhelming fatigue, the difficulties encountered with partners, friends and children who did not always understand why the person they loved had undergone such a major personality change, of being overweight or underweight, of the self-consciousness endured because of bulging eyes, thinning hair and thickened skin, and the effects these had on their self-esteem. Some described the heartache of not being recognized by friends they had not seen for some time.
These physical problems are often dismissed as trivial but, in a world where the pressure to look young and attractive is intense, they can become the cause of a huge amount of distress and self-loathing. They can also lead to other women’s health problems such as eating disorders.
Tip of the Iceberg?
In recent years, it has become apparent that thyroid problems may be even more common than ever imagined. The availability of more sophisticated methods of testing thyroid function has revealed that many seemingly healthy women with apparently normal thyroid function have, in fact, abnormal levels of hormones and antibodies against the thyroid gland. This also suggests that the cases of thyroid disease identified and treated may be only a fraction of what is actually out there.
Since 1995, such cases of mild or low-grade thyroid disease have received a great deal of attention in the medical and public media. Medical journals, such as the influential New England Journal of Medicine, have carried major articles on subclinical thyroid disease, while the shelves of bookshops now carry stacks of books about thyroid problems aimed at the general public. Many put forward the view that hidden thyroid problems are a factor in a host of conditions reaching epidemic proportions in the 21st century, including:
• Chronic fatigue
• Depression, anxiety and mood swings
• Difficulty in losing weight
• Eating disorders
• Menstrual problems
• Fertility problems, miscarriage and premature births
• Perimenopausal and menopausal problems
• Changes in libido
• Heart disease
• Osteoporosis
• Ageing.